University Information Services Help Desk
Voice: 202-687-4949, Fax: 202-687-1162
Email: netidservices@georgetown.edu, http://uis.georgetown.edu/

Account Termination Form for Main Campus/GUMC Employees


Complete this form at least five (5) days before the employees last day in the office and fax it to the Help Desk at    202-687-1162. The process may require the Help Desk to get in contact with the department with follow up questions or other issues.

Information regarding departing employee

Name __________________________________________  NetID __________________

Job title ________________________________________________________________

Date of last workday in the office _____________________________________________

Accounts the employee owned (please check all that apply)

      _____ NetID password                                                                    

      _____ GUMail account (includes deleting mail in the account)  

       _____ @georgetown.edu routing                                                  

       _____ Banner

       _____ Cognos

       _____ Genesys , include username _________

       _____ SIS, include username ________

       _____ PeopleSoft Financials

       _____ PeopleSoft Admissions

       _____ VPN

       _____ Web Account (for updating UIS-hosted sites)

       _____ Admin NetIDs/Aliases owned by departing employee, please list) _________________

Departmental contact in case of questions _____________________________________
(please include name AND phone number)

Department Head __________________________________________________

Department Head Signature ______________________________  Date _____________

(Department Head MUST sign for this to be valid)